Provider Demographics
NPI:1841316627
Name:MINNESOTA EYE INSTITUTE, INC.
Entity type:Organization
Organization Name:MINNESOTA EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-759-2020
Mailing Address - Street 1:3401 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3477
Mailing Address - Country:US
Mailing Address - Phone:320-759-2020
Mailing Address - Fax:320-759-2424
Practice Address - Street 1:3401 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3477
Practice Address - Country:US
Practice Address - Phone:320-759-2020
Practice Address - Fax:320-759-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31849174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN43Q15MIOtherBCBS
MNCK4923OtherRAILROAD MEDICARE
MN56221OtherHEALTHPARTNERS
MN727602800Medicaid
MNE076OtherUCARE
MN56221OtherHEALTHPARTNERS